About You
First Name *
Surname *
Home address *
Please tell us the address the dog currently resides at
Post Code *
Email address
Best contact number *
Please tell us your best contact number to enable us to call you back
Secondary contact number
Please upload a photo of your dog for our records *
Are you the legal owner of the dog? *
No Yes
If you're contacting us on behalf of someone else, please state your relationship with the legal owner? *
Where did you purchase your dog from? *
Rescue shelter
Preloved website/gumtree
Licensed Breeder
family/friend
I bred them myself
social media
other
If other, please state
How long have you owned this dog? *
Please provide a detailed description of why you're needing to relinquish your dog? *
Please understand we won't judge your situation, we need to understand the reasons you're needing to relinquish.
Please tell us why you need to rehome your dog. Please provide as much detail as possible. *
Please be honest with your reasons to rehome, as this will help staff when they call you to discuss.
Was your dog born in the UK? *
No Yes
Have you ever taken your dog to another country with you? *
No Yes
Your Dogs Details
Name of dog *
Date of birth of dog, approx age if unknown *
Sex of dog *
Male
Female
Description : Breed *
Colour *
Amber
Black
Black and Brindle
Black and Brown
Black and Tan
Black and White
Black Tortie
Blue
Blue Tortie
Brindle
Brindle and Black
Brindle and White
Brown
Brown and Black
Brown and White
Chocolate
Chocolate Tortie
Cinnamon
Cinnamon Tortoiseshell
Cream
Fawn
Fawn Tortoiseshell
Ginger
Ginger and White
Golden
Green
Grey
Grey and White
Light Amber
Lilac
Lilac Tortie
Liver
Liver and White
Ruddy
Seal
Silver
Sorrel
Sorrel Tortoiseshell
Tabby
Tabby and White
Tan
Tan and Black
Tan and White
Tortie
Tortie and White
Tricolour
Various
White
White and Black
White and Brindle
White and Brown
White and Grey
White and Liver
White and Tabby
White and Tan
White and Torti
Yellow and Grey
Is your dog neutered? If they are not please state the reason why? *
If the dog is not neutered and is female, please tell us the date of her last season?
Is the dog microchipped? *
No Yes
If yes, please tell us the microchip number
Are you the owner registered on this microchip? If not, who is the registered keeper? *
Is your dog upto date on their vaccinations? *
No Yes
If yes, please tell us when the dog was last vaccinated. (We would require either a vaccination card as proof of vaccination, or supplied veterinary history with dates of vaccination)
About Your Dog
Is your dog house trained? *
How many hours a day is your dog usually left on their own? Which part of the home are they left in? How do they behave when you're not there? *
Does your dog use a crate? Either in the home or car, if yes are they comfortable in there? *
What is your dogs current walking routine? *
Do you let your dog off the lead? *
No Yes
What type of walking aid do you currently use? (collar attached to lead, harness, a halti, extendable lead, longline ect) *
Does your dog pull much when on a lead? If so, under what circumstances? *
Has the dog lived with children? *
No Yes
If yes, please tell us the age of children the dog is used to
Please tell us what your dog is like around children? What behaviours do they display, are they comfortable? *
Is the dog used to cats? *
No Yes
What is your dogs reaction and behavior like around cats? *
Has the dog been around small animals? *
No Yes
What is your dogs reaction and behaviour like around small animals?
Has the dog been around livestock? *
No Yes
What is your dogs reaction and behavior like around livestock?
Please mention any behavioural issues your dog has: Please mention anything relevant - chasing vehicles, causing damage if left etc but also aggression towards strangers and anyone else including members of the family or other dogs/animals. *
Has your dog ever bitten a person or another dog? Have they ever showed any sign of aggression under any circumstances? Please be very honest with your answer and if the answer is yes, please describe the circumstance in as much detail as possible. *
Under what circumstances may your dog growl? *
Please tell us the type of walks you do with your dog? *
If yes, will your dog get down from the furniture when asked? How do you ask them to get down or get them off the furniture?
Does your dog have a tendency to mouth? (This is something puppies tend to do on your hands or arms. Most dogs grow out of this, however some don't) *
Is your dog allowed on the furniture? *
No Yes
Please describe your dogs reaction to strangers or guests when they come to the house? Please include people they know. The postman, work people entering the home and how your dog reacts to each. *
Where does your dog currently sleep and spend most of their time? *
Would you say your dog would be protective of you or others if you were approached? *
Will your dog chase anything such as traffic, birds, wildlife, joggers or bikes? *
Please describe your dogs temperament away from the home? Is their behaviour different? Do they act differently to people or under certain circumstances? *
Have you ever taken your dog to training classes? *
No Yes
If yes, please tell us where, who with and for how long for?
Please tell us the commands your dog responds to *
Has your dog ever lived with another dog? *
No Yes
If yes, please tell us the breed of the other dog, sex, age and how they got on.
Please describe your dogs reaction and behaviours to other dogs when out on a walk? Please let us know how they act on and off lead? Are they friendly, aggressive, shy, indifferent? Please give as much information as possible. *
Can you take toys off the dog? Do they ever show signs of guarding? *
Can you take food off the dog? Do they ever show signs of guarding? *
Can you take chews off the dog? Do they ever show signs of guarding? *
Please tell us the type of play your dog enjoys most and do they have a favorite type of toy? *
Is your dog happy to be bathed and groomed? *
Are you able to wipe your dogs feet and/or cut their nails? Please tell us how they behave. *
Is there any part of your dog where they are sensitive and are not overly keen on being touch? If yes please tell us where. *
How does your dog react to loud noises and fireworks? Please supply details of their reaction. *
Please tell us how your dog behaves whilst travelling in a car? *
How do you currently secure your dog in the car? Seat belt, crate etc *
Has your dog ever boarded in a kennel? *
No Yes
If yes, please tell us which kennels and how did your dog cope.
Please tell us how high your fences are in your garden? Please also state what type of fencing you have? *
Has your dog ever escaped from your garden? If so please explain the circumstances. *
Your Dogs Health and Diet
What brand of food are you currently feeding your dog (Brand, dry or wet), how often do you feed them and when are they fed? *
Is there a type of food that upset your dog digestion? If yes, please tell us what. *
Please describe your dogs feeding habits. *
Grazer
Finicky
Good appetite
Voracious
Please tell us when you last gave your dog a flea and worm treatment. In addition what bran of flea and wormer was given? *
If you have a female dog, has she ever had a litter? If yes, please tell us when.
Does your dog currently have any medical problems, or have they had any medical problems in the past? If yes, please explain the issues. *
Is your dog currently on any medication? If yes, please name the medication and what it is for. (Please note, if you bring your dog to us, we will need you to bring any current medication with you.)
Please give us the name of the vet you are registered with currently and any previous vets you may have been registered with. *
Please tell us when you last took your dog to the vet and what was the reason. *
Please tell us how your dog behaves when they visit the vet. Are they comfortable? Do they need to be muzzled? *
Please use this, box as an opportunity to tell us about your dogs personality? How would you describe them? *
If you could pick the ideal home for your dog, what would that be?
Disclaimers
Are you able to make a donation to help towards the care of the dog that you are looking to relinquish? We are a small charity and receive no government or lottery funding, so every donation will make a difference. *
No Yes
I confirm all members of my household are 100% in agreement to relinquish our dog and are aware I am making this application. *
No Yes
